The attorney general of Washington, D.C., is joining with his colleagues in 37 states to investigate the opioid crisis facing America.

The investigation is centered around the manufacturers of opioids and whether they have engaged in unlawful marketing practices, according to a press press release from the D.C. Attorney General’s office.

“If we turn up evidence that marketing practices played an unlawful role in the exponential growth of opioid prescriptions, rest assured: we will take action,” Attorney General Karl Racine said.

The Problem

This investigation comes after a release from the District’s Office of the Chief Medical Examiner released a report showing opioid deaths have increased drastically in the last two years.

In 2016, there were 216 deaths from opioids. This is a spike from 83 and 114 deaths in 2014 and 2015 respectively, according to the report.

The report also shows that fentanyl and heroin are the drugs used most often when a fatal overdose occurs.

This issue hits hardest in Wards 5, 7 and 8 in southern Washington. Ward 7 saw opioid fatalities double between 2015 and 2016. Fatalities have tripled in Wards 5 and 6. Only Ward 3 has reported fewer than 10 opioid fatalities in 2016.

The prevalence of opioids in these neighborhoods means that D.C.’s crisis impacts primarily African-American men.

2016 also saw a significant increase in deaths related to fentanyl and fentanyl analogs, as they surpassed deaths from heroin for the first time in Wards 1, 2, 5, 6, 7 and 8.

Fentanyl and its analogs are designer drugs that are designed to be more potent opioids and can be 100 times stronger than morphine.

After an initial decline in 2015, overdoses from prescription opioids spiked in 2016, with the OCME reporting 53 by November 2016 after reporting just 29 in 2015. Methadone and oxycodone were responsible for 29 of those deaths.

The Solution

The U.S. Department of Health and Human Services released a five-point strategy trying to stop this crisis:

Improving access to treatment and recovery services,

Promoting use of overdose-reversing drugs,

Strengthening our understanding of the epidemic through better public health surveillance,

Providing support for cutting-edge research on pain and addiction, and

Advancing better practices for pain management.

D.C. is starting its own initiatives. For several months in 2015, Mayor Muriel Bowser instituted the Screening, Brief Intervention, and Referral to Treatment pilot program. Through the program, the Department of Fire and Emergency Medical Services worked with the Department of Behavioral Health to offer treatment to people who experienced opioid overdoses.

The data gathered from this pilot program has led to the implementation of other health programs. For example, D.C. has begun a program to train and certify staff and volunteers involved in needle exchange programs to administer naloxone, a drug that can save people from overdoses. The mayor’s office reports that since May 2016, more than 250 lives have been saved with naloxone kits.

Additionally, government offices have, for the last three years, required that every drug involved in a death be listed on the death certificate to allow for better tracking of the different drugs that enter the city.

Furthermore, Mayor Bowser has announced the expansion of Medication-Assistant Treatment, which uses the drug suboxone to fight withdrawal systems while also providing counseling.

On a national scale, President Trump said that he will make an announcement regarding the opioid crisis next week and many expect him to officially declare a national emergency, according to the Guardian. The Trump administration has been drawing up documents to outline exactly what powers this declaration will give the president since August, according to the Atlantic.